Provider Demographics
NPI:1952380271
Name:HUMPHREYS, JANET B (MSN, MPH, ANP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:B
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:MSN, MPH, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:1408 NEWCROSS RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6052
Practice Address - Country:US
Practice Address - Phone:865-691-4794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008246363LA2200X
TNRN00001331411163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3929328Medicaid
TNP00095279OtherRAILROAD MEDICARE
TNP00095279OtherRAILROAD MEDICARE
TN3929328Medicare PIN